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Recently, I switched from working in a small town of ~12,000 with <10 min transport times to a rural area with extended transport times. It's around 30 minutes to our nearest hospital, and at least an hour (depending on location in county) to the nearest hospitals with PCI, neuro, trauma, etc. capabilities.

One thing I've noticed is that my scene times have increased for most patients without an absolutely time critical diagnosis. Previously, I would average 10-15 minutes (IV, O2, monitor - meds enroute) on a scene and now it's 15 - 25 minutes. I tended to think the opposite would be true since more could be done while enroute, and that is the case with patients with acute CVA, STEMI, etc. unless they have acute symptoms that need immediate stabilization. With other patients I tend to give more treatments while on scene with my partner and hopefully see results while transporting.

I'm also doing a lot more procedures - which I expected. That might also be contributing to longer scene times.

I'm interested in your thoughts - do you "stay and play" or treat while transporting?

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Though I know it's an unpopular opinion, I've held, and continue to hold the opinion that movement and transport are really stressful things. That if I can improve a weak patients condition prior to d

I think this depends a lot on the culture and the medical direction in a given urban system, as well. For example, in one of the urban systems I worked in, it was unacceptable to transport a potentia

I didn't re-read this whole thread, so I am not sure if this has been said before, but I treat my patients to the max of my protocol/knowledge even if it means extended scene times because I KNOW I pr

It really depends on what the patients complaint is. We cover some very rural areas of northern PA, with some transport times going over the 30 min mark. We also cover a medium sized city where transport times are less than 10 minutes. If I'm out in the sticks, I load the patient and go because I have LOTS of time to do my interventions if needed. If I'm in the city, general illness, headaches and the like have short scene times. MI's, strokes, respiratory distress, they get the monitor and O2, I get the IV enroute.

Our protocols state that an acute MI is less than 10 min scene time, strokes are the same. For strokes we check a BGL before we put the monitor on, then the monitor and O2 and we are rolling.

I guess I'm not sure why you are staying on scene for extended periods of time for any patient, especially with long transport times. I'm not saying you're wrong, I'm just thinking that if you have a long tranpsort time, why not just get moving and do everything on the ride in.

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Not altogether uncommon to find yourself doing more "stuff" since you have more time with the patient anyway.

Having worked in a mix of short and long transport time areas, my tendency is to do more enroute, or in my ambulance than sitting on scene and having to fight with everything getting the patient out. You might find yourself becoming better at doing things while moving at some point too.

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Why do you feel your scene times have increased?

Is it because you are doing a more thorough assessment ?

Are you doing procedures that can be done while enroute for an extended ride to hospital?

Are you spending time getting more info on scene than you used to?

from past experience, It always seemed that city medics tended to spend more time on scene as their transport times are short.<10min to a choice of ER's

My average scene time in our rural setting is less than 10 min on every call unless their is a difficulty removing the pt or in case of a code where we work them for 20 minutes or ROSC.

Many of our scene times are under 5 min.

We've got a minimum of 30 min transport time in good weather to the nearest small ER and well over an hour to a level 1 trauma center with cath lab and stroke center capabilities.

Plenty of time to do all our interventions while traveling down the road in my office!

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I find that a contributing source of longer scene times is the seemingly laid back attitude of those in Rural areas.

When I was working urban ems my scene times were quite short. If they fit they ship

I found when working rural that I knew most everyone I was seeing so it was easy to get lost in a conversation while doing things and wham, you realize that all your interventions have been done on scene and the transport was smooth.

By no means did my scene times extend if the patient condition warranted them, ergo if they were really sick, load and go and transport and perform what was needed on the ride to the hospital.

But I think that a rural area is more relaxed and slow going so the scene times should accurately reflect that, in my experience at least.

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Like was said before, it depends what is wrong. We've been combating "Body Snatcher" syndrome for all the years I've been actively involved. You know, load and go, scoop and swoop.. ALS wasn't available till the very start of the 1990's.. So, quite a substantial time into the EMS age, the best treatment that could be given was a fast ride to the hospital.

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Didn't mean scoop and run at all: Like you I know a large percentage of our Pt's on a first name basis .

the kind of small town where they call me at home and ask if they should call 911 or ask us to come check on grandpa,cause he's just not right today.

Rather than hauling all your tools into the house, take the basics with you and make the decision to spend the morning sitting holding their hands or get off the pot and get them headed down the road at a safe comfortable pace while you do all the needed interventions. No need to be wasting all that travel time just holding hands because everything was done on scene. Yes there is always the diabetic that you wake up with a line and d-50 that takes an extended scene time .

But you don't want to fall in the habit of 30 minutes becoming the norm.

We do very little code 3 running here due to the roads and weather conditions, so there is plenty of time to get most everything including the PCR done.

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At my service we alternate between working a city post one month and working one of the outlying "rural" posts the next. This month I'm out in the county and we average about 20 minute transport times to the nearest hospital. Not really rural like most of you guys, I know, but compared to my city post (which is less than a block away from one of the local hospitals), it feels rural to me!

Anyway, back to the topic, I notice that I do more en route when we're out here in the boonies than I do in the city. In town, I'll have an IV bag set up and ready to go and I'll usually get my EKG and my stick before we get going (and a med or two depending on what it is and what the patient needs), but when we're at the vacation station I tend to just get my EKG and do the rest en route. Personally, I like taking my time on scene (or, rather, in the back of the truck on scene) to get stuff done (and make sure it gets done and I don't run out of time before we make it to the hospital), than to fumble around the whole way in and find out that I wasn't able to get any care done en route.

I guess I'm not so great at the "mobile" part of the job, haha. My advice for you would be to take as much or as little time as you need to deliver the most appropriate care to your patient. Most of our patients need no treatment from us, and those that do typically don't need high flow diesel to be stabilized.

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Though I know it's an unpopular opinion, I've held, and continue to hold the opinion that movement and transport are really stressful things. That if I can improve a weak patients condition prior to doing so that that is a good thing.

And I seem to find that it gives patients a chance to get some meds onboard, some fluids, get a breathing treatment in, a bit of a chance for them to get used to the chaos that they perceive of patient care before being lifted and wheeled around by strangers.

But again, having spent nearly all of my time as a provider in rural or remote areas, my opinions almost certainly wouldn't hold in an urban environment. But if you have the time to improve a patient before stressing them, and can do so without queering system status, what is the down side really?

Dwayne

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